Journal of Birjand University of Medical Sciences
Year:2009 | Volume:16 | Issue:3 (40)|Papers Count:13

Background and Aim: Nausea and vomiting after surgery and anesthesia, cause longer stay of the patient in recovery room and also leads to complications such as electrolyte disturbances, dehydration, hemorrhage from the site of sutures and pulmonary aspiration. This study compared the preventive effect of metoclopramide and low-dose propofol on nausea and vomiting after cesarean section.Materials and Methods: In this double blind clinical trial, 120 candidate patients for cesarean section (C/S) were randomly divided into two groups. The age range of patients was 17 to 34 years and all were in ASA class 1 and 2. Anesthesia induced in the same condition for all patients. 3 minutes before the end of surgery, all inhaled drugs were stopped and in one group, propofol (0.5 mg/kg) and in the other group, metoclopramide (0.2 mg/kg) was administered. All the patients had been controlled for nausea and vomiting up to 6 hours post-operation. Data were analyzed by means of SPSS, using t-test and chi-square at the significant level of P<0.05.Results: There was no significant difference on age, weight and duration of surgery between the two groups.The frequency of vomiting in 1 hour after surgery in propofol treatment group (16.7%) was significantly less than metoclopramide treatment group (55%) (P<0.0001). However, there was no significant difference in 2-6 hours after surgery (36.7% and 51.7% respectively, P>0.05). Frequency of nausea in propofol treatment group in the first (30%) and 2-6 hours (36.7%) after surgery was significantly lower than the metoclopramide group(60% and 58.3%, respectively, P<0.01).Conclusion: Propofol (0.5 mg/kg) in the prophylaxis of nausea and vomiting in the first hour after C/S was more effective than metoclopramide. Moreover, its effect on lowering the frequency of nausea in the 2-6 hours postoperative was more than metoclopramide.

Background and Aim: Methotrexate (MTX) as a chemotherapeutic agent is used for the treatment of a variety of tumors and inflammatory diseases. Different studies have shown that methotrexate has inhibitory effects on oogenesis and spermatogenesis, and causes impair fertility and different pathological changes in testis of laboratory animals. The aim of this study is to investigate the effect of methotrexate administration on spermatogenesis indexes in the testis of adult male rats.Materials and Methods: In this experimental study, 40 male Wistar rats were randomly divided into experimental (n=20) and control (n=20). The first and the second experimental groups were received MTX (1 mg/kg, IP) per week for two and four consequence week, respectively. The first and second control groups just received normal saline (10 ml/kg, IP) per week for two and four consequence weeks, respectively.Tissue sampling of the testis was done after the mentioned time for each group, tissue slices were stained by H&E technique. Histological and spermatogenesis indexes which include: tubular differentiation index (TDI), spermiogenesis index (SI), and repopulation index (RI), were studied. Data were analyzed by ANOVA at the significant level of P<0.05.Results: This study showed that methotrexate had destructive effects on testis tissue and spermatogenesis in treated group compared with the control. Also, results showed that TDI, RI and SI had non significant decreased in 14th day, but in 28th day after treatment with MTX, all indexes were significantly decreased compared with control group (P<0.001).Conclusion: This study showed that methotrexate administration (for 28 days, once a week) causes reduction of spermatogenesis and its indexes in rat testis tissue, probably due to reducing of cell divide and toxic effect of MTX. However, more studies are needed, to investigate the effect of this drug on spermatogenesis and infertility in human.

Background and Aim: Hand injuries due to lacerations are one of the most common causes of hand emergencies which are due to diverse reasons as occupational, sport injuries or self mutilation. Tendons’ damages are the most common injuries of hand. Precise preoperative examination may reduce diagnostic errors. This study evaluated the accuracy of preoperative examinations of flexor tendons injuries in zone 4 and 5 of hand.Materials and Methods: In a cross-sectional descriptive study, preoperative physical examination by plastic surgery team and findings during the surgery were compared in 61 cases referring to hand emergency operating room of 15 Khordad Hospital, Tehran. Data collection was preformed by means of questionnaires pre and post operation. All cases with hand lacerations of zone 4 & 5 were enrolled, whereas children younger than 3 years of age, and the non-cooperative cases and those of any history of previous handsurgery, were excluded from the study. Sensitivity, specificity, positive and negative predictive values were analyzed, using SPSS software.Results: The accuracy of preoperative examination findings for all tendons was 88.52%. This was more accurate in flexor digitorum profundus (FDP) (96.72%) than flexor digitorum superficialis (FDS) tendons (78.27%). The specificity of preoperative examination (99.50%) was more than sensitivity (57.63%) for all tendons. Sensitivity of examination for FDS and FDP was 40.69% and 82.75% respectively and specificity was 98.73% and 100% for FDS and FDP respectively.Conclusion: More attention is mandatory during preoperative examination of the hand with zone 4 & 5 injuries. Surgeons need a low exploratory threshold, and in cases with any positive finding of tendon injury, explorative surgery is recommended.

Background and Aim: One of the important changes during pregnancy is weight gaining of pregnant women that is one of reliable indicators of nutrition controlling. Pregnancy weight gain is measured by the rate of Body Mass Index (BMI) before pregnancy and standard criteria of American Institute of Medicine (IOM). This study was designed to evaluate the pattern of weight gain in pregnant women referred to health centers of Birjand.Materials and Methods: This descriptive - analytic study was performed in 2007 on 347 healthy pregnant women who referred to health centers of Birjand in 2007. BMI before pregnancy was recorded for all mothers, and repeated at regular visits, at least between 3rd to 9th months of pregnancy. Mothers who suffered from pregnancy induced hypertension, gestational diabetes, abnormal swelling and signs of preeclampsia or those with multigestational pregnancy were excluded from the study. Body weight during different months of pregnancy, were retrieved from information on pregnant women care in the health centers. The data were analyzed by SPSS using relevant statistical tests at the significant level of P<0.05.Results: The mean weight gain in the third quarter was 5.34±2.79 Kg, and during the whole of pregnancy was 10.46±4 Kg. Weight gain in mothers with BMI less than 19.8 was 10.86±3.88 Kg, mothers with 19.8<BMI<26 was 10.59±4.04 Kg, for those with 26.1<BMI<29 was 10.82±4.19 Kg, and in mothers with BMI>29, was 8.77±3.57Kg. Significant correlation was observed between weight gain during pregnancy and BMI before pregnancy (P=0.009), maternal age (P<0.001), and birth weight (P<0.05). Moreover, a significant correlation was seen between the mean weight gain and rank of birth baby (P=0.002), and level of mother's education (P=0.004).Conclusion: Weight gain during pregnancy among pregnant women in Birjand is lower than the standard of IOM, which may be due to nutrition factors or maternal care during pregnancy.

Background and Aim: Brucellosis is one of the most important worldwide zoonoses, which is endemic in many areas of Iran. As clinical findings are various and confusing in brucellosis, simple, inexpensive and valid laboratory tests would be helpful to diagnose the infection. This study aimed to evaluate the validity of Standard common serological test (Wright’s) in the diagnosis of brucellosis.Materials and Methods: In this study, 340 patients with diagnosis of brucellosis were randomly selected from admitted patients in infectious disease ward, and Wright’s serologic test was studied. The sensitivity of Wright’s test was calculated according to the basis of 1.160 and 1.80 titers. For calculating the specificity of this test according to the basis of 1.160 and 1.80 titers, 160 non-brucellosis patients with Wright’s test results were selected as a control group.Results: Out of 340 patients, 53.8% were male and 46.2% were female and from 160 controls, 52.7% were male and 47.3% were female. The sensitivity of Wright’s test was 91.8% and 80.6% based on 1.80 and 1.160 titers, respectively. The specificity of Wright’s test was 97.5% and 100% based on 1.80 and 1.160 titers, respectively.Conclusion: According to the obtained results, it should be stated that Wright’s test, which commonly is used in epidemiologic and diagnostic studies, has a significant validity and still can be used as a screening test based on 1.80 and as a diagnostic test based on 1.160 titer. It is obvious that other laboratory tests and if necessary, culture, may be used for definite diagnosis.

Background and Aim: Nosocomial infections (NI) are infections that occur during admission time in the hospital. Data regarding the incidence of NI is variable between 2.8-10% in different centers. The most common causes of these infections are iatrogenic, organization and patient risk factors. According to high physical lesions and financial losses imposed by these infections and the lack of accurate statistics regarding this topic, we aimed to evaluate the frequency of NI and the related factors.Materials and Methods: In a prospective descriptive study, all admitted patients in different wards of Imam Hossein(as) hospital of Shahrood in 2005, who had the diagnostic criteria of NI were included and full laboratory studies were performed. The annual incidence rate and incidence density of NI was calculated.Data were analyzed by SPSS using relevant statistical tests.Results: Among 23816 admitted patients in this hospital, 98 patients (46 males and 52 females) with mean age of 55.7±23.9 years (ranging 5 to 98 years) were diagnosed as NI. Overall incidence rate of NI was 41/10000 patients. Incidence density in ICU was 54.1, in neurology ward was 37.2, internal medicine ward was 16.6 and in orthopedic ward was 12.5/10000 patients/day. Regarding the etiology of infection, E-coli were found in 64.3%, coagulase-negative Staphylococcus in 11.2% and Klebsiella in 8.2% of cases. Among patients with NI, urine catheter was seen in 66.3%, tracheal intubations in 14.3% and surgical wounds were seen in 13.2% of patients.Conclusion: The results of this study indicate the lower frequency of NI in comparison with the national results. Proper and timely use of medical interventions, hand washing especially for health personnel, health education, continuous supervision, correct use of disposable equipments, controlled use of antibiotics good care of surgical wounds are the most important to be considered.

Background and Aim: Suitable growth and development of infants is dependent on correct feeding and proper nutritious habits. Lack of mothers’ knowledge and their improper practice regarding nutrition in infancy, is one of the important reasons of malnutrition in this period. This study was designed to assess the pattern of one-year infants’ complementary nutrition and mothers’ knowledge about it and some of its related factors.Materials and Methods: This descriptive-analytical, cross-sectional study was conducted in winter 2006 on 260 mothers who referred to Birjand health centers for MMR vaccination of their one-year infants. A questionnaire was completed through interview with mothers. Data were analyzed by SPSS using t-test, ANOVA and chi-square test.Results: The mean age of starting complementary nutrition in studied infants was 5.55±1.03 months which showed significant correlation with level of education and maternal age (P<0.05). There was not significant correlation between the age of starting complementary nutrition and parents’ job, paternal age and level of education, family income, sex of child and order of birth. The most common pattern of beginning complementary food was rice mucilage, pudding and almond porridge, respectively. Level of mothers’ knowledge regarding the pattern of complementary nutrition in infants was poor in 8.1%, middle in 65.4% and good knowledge was observed in 26.5% of mothers. A significant correlation between level of mothers’ knowledge and their level of education, job and age was found (P<0.05).Conclusion: This study showed that unfortunately mothers’ information about the importance of complementary nutrition in infants was not enough. It seems that one of main causes is the lack of necessary trainings in mothers.

Background and Aim: Cardiovascular diseases (CVD), especially coronary heart diseases (CHD) are major causes of death in developed countries. Studies have been shown that total plasma homocysteine (tHcy) has been associated with an increased risk of CHD, probably a causal type. A lower tHcy concentration will reduce the frequency of CHD. The aim of this study was to evaluate the correlation between tHcy and CHD and its relationship with other CVD risk factors such as oxidized low density lipoprotein (ox-LDL).Materials and Methods: A total number of 260 patients with coronary angiography indication were included in this case control study. The study group consisted of 130 patients with at least one vessel stenosis greater than 50% and the control group consisted of 130 normal angiogram without stenosis. Total Hcy, cholesterol, triglyceride, high density lipoprotein (HDL) and its sub fractions, low density lipoprotein (LDL) and ox-LDL were measured in two groups. Data were analyzed by SPSS using relevant statistical tests at the significant level of P<0.05.Results: The mean serum tHcy level in CVD patients (19.25±8.20 mol/L) was significantly higher (P<0.001) than the control group (14.8±4.17 mol/L). Moreover, among patients with CVD, a positive significant correlation between tHcy and ox-LDL level in plasma, was found (r=0.426, P<0.001). Despite reduced HDL2 concentration in patients with CVD than the control group, no significant correlation between high tHcy and low HDL2 was achieved in this study.Conclusion: Beside other known effects, homocysteine may also act as a risk factor for cardiovascular diseases by increasing plasma ox-LDL concentration.

Background and Aim: During the intense and prolonged exercise, muscle and tissue damages may occur due to production of free radicals and other reactive oxygen compounds. Therefore, the purpose of this study was to compare antioxidant status and lipid profile of karate athletes and non-athlete individuals.Materials and Methods: In a descriptive analytical study, 17 healthy active male karate athletes, who have continues exercise training during previous 6 months for at least 3 sessions per week, each session lasted 45 minute, and 20 male non-athletes without previous history of regular exercise in the same time, were selected randomly. Total antioxidant capacity, superoxide dismutase (SOD) activity, lipid concentration, maximal oxygen uptake (VO2 max) and legs anaerobic power were determined through standardized and valid methods. Mann-Whitney tests was used to compare groups with Q=0.05.Results: The SOD activity, VO2 max and legs peak anaerobic power of karate athletes were significantly higher (P<0.05), and body mass index and body fat percentage of them were significantly lower (P<0.05) than non-athlete individuals. However, there were not significant differences between the two groups regarding their lipid concentrations and other antioxidant indexes (P>0.05).Conclusion: Karate athletes have more favorable antioxidant system, physical fitness, and body composition than non-athletes, and these factors make them more resistance against cardiovascular diseases and atherosclerosis.

Aphasia is a speech disorder which is caused as a result of a lesion in the frontal or temporal lobe. In the present article, a patient suffering from Broca aphasia, caused by a strike on the area responsible for speech in her brain, is studied. In speech therapy sessions of this patient, it was found that, this patient passed the same stages as learning her mother tongue to re-learn her language. For example she used overgeneralization, moved from concrete learning to conceptual learning, articulated the simpler consonants first and moved from sounds which are produced by the lips to the ones produced by glottis. It seems that if the speech therapist is aware of the findings of psycho-linguistics, especially the first language acquisition process, it can help to improve the condition of these patients. At the end, it suggests that a linguist accompany the speech therapist and physiotherapist in speech therapy sessions.